PRTF definition
Examples of PRTF in a sentence
Unless covered by an EPSDT exception, members receiving treatment in a psychiatric residential treatment facility (PRTF) are not the Contractor’s responsibility and will be disenrolled from Hoosier Healthwise.
The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee-for-Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate.
In these cases, the Contractor shall work with the PRTF on discharge planning.
As part of the discharge planning process the PRTF shall evaluate the member for transition to the Medicaid fee-for-service.
If Medicaid fee- for-service enrollment is not appropriate or accessible, the member will be reenrolled with the Contractor upon PRTF discharge.
Members who are admitted to a PRTF shall have their enrollment with the Contractor suspended.
If Medicaid fee-for-service enrollment is not appropriate or accessible, the member will be reenrolled with the Contractor upon PRTF discharge.
The MCOP is not required to pay for the State Plan services targeted case management for youth with moderate or significant behavioral health challenges, intensive home-based treatment (IHBT), and psychiatric residential treatment facilities (PRTF) which are the responsibility of the OhioRISE plan through a separate non-risk payment arrangement.
If an Enrollee’s MCO enrollment changes during a PRTF stay, the new MCO will be financially responsible for the stay beginning on the first day of coverage with the new MCO.
If an Enrollee becomes Medicaid eligible and enrolled in the MCO while admitted to the PRTF, the certification of need for services is completed by the treatment team at the PRTF.